G Model REMNIM-772; No. of Pages 2
ARTICLE IN PRESS Rev Esp Med Nucl Imagen Mol. 2016;xxx(xx):xxx–xxx
Interesting image
FDG PET/CT imaging of metastatic renal squamous cell carcinoma Imagen PET/TC de carcinoma renal de células escamosas metastásico S.Y. Aksoy a,∗ , E. Özdemir a , Z. Kandemir a , N. Yıldırım a , S¸. Türkölmez b a b
Ankara Ataturk Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey Yıldırım Beyazıt University, Ankara Ataturk Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey
Case report We report FDG PET/CT findings of metastatic renal squamous cell carcinoma (SCC) in a 65-year-old male patient. Whole-body FDG PET/CT showed mass lesion with very intense FDG uptake involving pelvis and the lower pole of left kidney, hypermetabolic
foci at the liver and slightly hypermetabolic mesenteric lymph nodes as well as bilateral kidney stones (Fig. 1). There was no other pathological finding in the remaining part of the body (Fig. 2). Primary renal SCC is an uncommon tumor representing less than 1% of all urinary tract neoplasms. SCC is frequently associated with long standing calculus disease and hydronephrosis, as in our case.
Fig. 1. A 65-year-old man who had the history of open nephrolithotomy surgery 4 years earlier presented with fever and left flank pain of 3-months duration as well as draining skin lesion at the same region. Abdominal CT which was performed with the presumed diagnosis of perirenal abscess showed ill-defined left renal mass-like lesion with necrotic component. Tru-cut biopsy confirmed it as squamous cell carcinoma (SCC). The physical and endoscopic examination of the head and neck region including nasopharynx, oropharynx and larynx was unremarkable. FDG PET/CT was performed for the identification of the possible unknown primary site and distant metastases. Axial CT (A) and fusion (B) images of PET/CT scan demonstrated 98 × 101 × 108 mm mass lesion with very intense FDG uptake (SUVmax: 30.2) involving pelvis and the lower pole of left kidney. The lesion was also infiltrating left lateral oblique muscles and invading the skin. There were also multiple hypermetabolic foci at the liver (C, D) and slightly hypermetabolic mesenteric lymph nodes as well as bilateral kidney stones.
∗ Corresponding author. E-mail address: sbr [email protected] (S.Y. Aksoy). http://dx.doi.org/10.1016/j.remn.2015.12.005 2253-654X/© 2016 Elsevier España, S.L.U. and SEMNIM. All rights reserved.
Please cite this article in press as: Aksoy SY, et al. FDG PET/CT imaging of metastatic renal squamous cell carcinoma. Rev Esp Med Nucl Imagen Mol. 2016. http://dx.doi.org/10.1016/j.remn.2015.12.005
G Model REMNIM-772; No. of Pages 2 2
ARTICLE IN PRESS S.Y. Aksoy et al. / Rev Esp Med Nucl Imagen Mol. 2016;xxx(xx):xxx–xxx
Fig. 2. Coronal slices of CT (A), fused PET/CT (B) and MIP (C) images demonstrated hypermetabolic left renal mass and liver metastases. There was no other pathological finding in the remaining part of the body and the patient was diagnosed as primary renal SCC with liver and lymphatic metastasis.
The clinical symptoms are generally nonspecific and similar to renal stone disease which makes the diagnosis difficult. Histopathology plays a crucial role for final diagnosis. However, primary renal SCC should further be differentiated from metastatic SCC by combination of clinical-imaging findings, and histopathology. Renal SCC has a poor prognosis with the 5-year survival rate of no more than 10%.1 18 F-FDG PET/CT findings of renal SCC have been reported previously.2 We probably report the first case of metastatic renal SCC imaged by PET/CT. The interpretation of PET/CT images in the evaluation of malignant urinary tract lesions may be difficult because 18 F-FDG is excreted by the kidney. Additionally, variable FDG uptake of renal masses causes limited role of FDG PET/CT in the staging of these tumors.3 PET/CT could be effectively used in the staging of renal SCC which show higher FDG uptake and also
in the diagnosis of renal malignancy especially in patients with long standing calculus disease to help in differentiation of SCC and renal stone symptoms. It is also helpful in discriminating primary and metastatic SCC by demonstrating any possible primary site throughout the body. References 1. Holmang S, Lele SM, Johansson SL. Squamous cell carcinoma of the renal pelvis and ureter: incidence, symptoms, treatment and outcome. J Urol. 2007;178:51–6. 2. Hsieh TC, Wu YC, Sun SS, Chiang IP, Yang CF, Yen KY, et al. Synchronus squamous cell carcinomas of the esophagus and renal pelvis. Clin Nucl Med. 2011;36:171–4. 3. Kumar R, Chauhan A, Lakhani P, Xiu Y, Zhuang H, Alavi A. 2-Deoxy-2-(F18)fluoroD-glucose-positron emission tomography in characterization of solid renal masses. Mol Imaging Biol. 2005;7:431–9.
Please cite this article in press as: Aksoy SY, et al. FDG PET/CT imaging of metastatic renal squamous cell carcinoma. Rev Esp Med Nucl Imagen Mol. 2016. http://dx.doi.org/10.1016/j.remn.2015.12.005
ARTICLE IN PRESS Rev Esp Med Nucl Imagen Mol. 2016;xxx(xx):xxx–xxx
Interesting image
FDG PET/CT imaging of metastatic renal squamous cell carcinoma Imagen PET/TC de carcinoma renal de células escamosas metastásico S.Y. Aksoy a,∗ , E. Özdemir a , Z. Kandemir a , N. Yıldırım a , S¸. Türkölmez b a b
Ankara Ataturk Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey Yıldırım Beyazıt University, Ankara Ataturk Training and Research Hospital, Department of Nuclear Medicine, Ankara, Turkey
Case report We report FDG PET/CT findings of metastatic renal squamous cell carcinoma (SCC) in a 65-year-old male patient. Whole-body FDG PET/CT showed mass lesion with very intense FDG uptake involving pelvis and the lower pole of left kidney, hypermetabolic
foci at the liver and slightly hypermetabolic mesenteric lymph nodes as well as bilateral kidney stones (Fig. 1). There was no other pathological finding in the remaining part of the body (Fig. 2). Primary renal SCC is an uncommon tumor representing less than 1% of all urinary tract neoplasms. SCC is frequently associated with long standing calculus disease and hydronephrosis, as in our case.
Fig. 1. A 65-year-old man who had the history of open nephrolithotomy surgery 4 years earlier presented with fever and left flank pain of 3-months duration as well as draining skin lesion at the same region. Abdominal CT which was performed with the presumed diagnosis of perirenal abscess showed ill-defined left renal mass-like lesion with necrotic component. Tru-cut biopsy confirmed it as squamous cell carcinoma (SCC). The physical and endoscopic examination of the head and neck region including nasopharynx, oropharynx and larynx was unremarkable. FDG PET/CT was performed for the identification of the possible unknown primary site and distant metastases. Axial CT (A) and fusion (B) images of PET/CT scan demonstrated 98 × 101 × 108 mm mass lesion with very intense FDG uptake (SUVmax: 30.2) involving pelvis and the lower pole of left kidney. The lesion was also infiltrating left lateral oblique muscles and invading the skin. There were also multiple hypermetabolic foci at the liver (C, D) and slightly hypermetabolic mesenteric lymph nodes as well as bilateral kidney stones.
∗ Corresponding author. E-mail address: sbr [email protected] (S.Y. Aksoy). http://dx.doi.org/10.1016/j.remn.2015.12.005 2253-654X/© 2016 Elsevier España, S.L.U. and SEMNIM. All rights reserved.
Please cite this article in press as: Aksoy SY, et al. FDG PET/CT imaging of metastatic renal squamous cell carcinoma. Rev Esp Med Nucl Imagen Mol. 2016. http://dx.doi.org/10.1016/j.remn.2015.12.005
G Model REMNIM-772; No. of Pages 2 2
ARTICLE IN PRESS S.Y. Aksoy et al. / Rev Esp Med Nucl Imagen Mol. 2016;xxx(xx):xxx–xxx
Fig. 2. Coronal slices of CT (A), fused PET/CT (B) and MIP (C) images demonstrated hypermetabolic left renal mass and liver metastases. There was no other pathological finding in the remaining part of the body and the patient was diagnosed as primary renal SCC with liver and lymphatic metastasis.
The clinical symptoms are generally nonspecific and similar to renal stone disease which makes the diagnosis difficult. Histopathology plays a crucial role for final diagnosis. However, primary renal SCC should further be differentiated from metastatic SCC by combination of clinical-imaging findings, and histopathology. Renal SCC has a poor prognosis with the 5-year survival rate of no more than 10%.1 18 F-FDG PET/CT findings of renal SCC have been reported previously.2 We probably report the first case of metastatic renal SCC imaged by PET/CT. The interpretation of PET/CT images in the evaluation of malignant urinary tract lesions may be difficult because 18 F-FDG is excreted by the kidney. Additionally, variable FDG uptake of renal masses causes limited role of FDG PET/CT in the staging of these tumors.3 PET/CT could be effectively used in the staging of renal SCC which show higher FDG uptake and also
in the diagnosis of renal malignancy especially in patients with long standing calculus disease to help in differentiation of SCC and renal stone symptoms. It is also helpful in discriminating primary and metastatic SCC by demonstrating any possible primary site throughout the body. References 1. Holmang S, Lele SM, Johansson SL. Squamous cell carcinoma of the renal pelvis and ureter: incidence, symptoms, treatment and outcome. J Urol. 2007;178:51–6. 2. Hsieh TC, Wu YC, Sun SS, Chiang IP, Yang CF, Yen KY, et al. Synchronus squamous cell carcinomas of the esophagus and renal pelvis. Clin Nucl Med. 2011;36:171–4. 3. Kumar R, Chauhan A, Lakhani P, Xiu Y, Zhuang H, Alavi A. 2-Deoxy-2-(F18)fluoroD-glucose-positron emission tomography in characterization of solid renal masses. Mol Imaging Biol. 2005;7:431–9.
Please cite this article in press as: Aksoy SY, et al. FDG PET/CT imaging of metastatic renal squamous cell carcinoma. Rev Esp Med Nucl Imagen Mol. 2016. http://dx.doi.org/10.1016/j.remn.2015.12.005
